AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-How to_ Arthroscopic Labral, SLAP, and Instability Repairs, Capsular Plication-Dr. Robin M. Gehrmann, MD

How to_ Arthroscopic Labral, SLAP, and Instability Repairs, Capsular Plication-Dr. Robin M. Gehrmann, MD

Pdf Summary

This lecture by Dr. Robin M. Gehrmann covers arthroscopic labral repairs and capsular plication for shoulder instability, focusing on anatomy, pathology, surgical techniques, and outcomes.<br /><br />The shoulder is the most commonly dislocated joint due to its anatomical design—not a true ball-and-socket joint and reliant heavily on the labrum and capsule for stability. The labrum deepens the glenoid socket, increases articular conformity, and serves as an attachment for the glenohumeral ligaments.<br /><br />Instability is classified by direction (anterior, posterior, multidirectional) and cause (traumatic or atraumatic). Anterior traumatic instability is most common, often due to hyperabduction and external rotation forces causing a capsulolabral avulsion (Bankart lesion) at the 3-6 o’clock glenoid position. Variants include ALPSA lesions where the labrum avulses but the periosteum remains intact. Posterior instability is less common, often underdiagnosed, presenting with pain and subluxation. Multidirectional instability involves symptomatic subluxation/dislocation in multiple directions, often associated with generalized ligamentous laxity.<br /><br />Arthroscopic repair is preferred in first-time dislocators and those with minimal bone loss, offering advantages such as less blood loss, shorter operative time, faster rehab, and preservation of muscle, but is technically demanding. Patient selection is critical; open surgery may be better for young collision athletes or those with bone loss.<br /><br />Key surgical goals are to restore anatomy, prevent instability, maintain full range of motion, and allow return to sports. Techniques include complete capsulolabral release, preparing a bleeding bone bed, and shifting or plicating the capsule superiorly and laterally for anterior instability or plicating for posterior. Rotator interval closure is used to reduce capsular volume in multidirectional instability.<br /><br />Outcomes show arthroscopic repair with suture anchors yields excellent stability and low recurrence when properly executed. The lecture emphasizes careful evaluation, portal placement, and individualized treatment planning for optimal results.

Keywords

arthroscopic labral repair

capsular plication

shoulder instability

Bankart lesion

ALPSA lesion

anterior shoulder instability

posterior shoulder instability

multidirectional instability

rotator interval closure

suture anchors